Healthcare Provider Details

I. General information

NPI: 1144147653
Provider Name (Legal Business Name): LUIS ANTONIO BRACERO BAUMGARTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 CALLE FORTUNA
PONCE PR
00717-2304
US

IV. Provider business mailing address

1955 CALLE FORTUNA
PONCE PR
00717-2304
US

V. Phone/Fax

Practice location:
  • Phone: 787-439-8717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2359
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: